Hope you are well

Seek your help on the following situation

I had an exposure with a high-end escort. We had protected sex, but the condom broke, for say 20-30 seconds. The escort is high end (+USD 500) and seems to be careful. 

Obviously i am worried, so i tested on week 1 and week 4 at the clinic for syphilis and HIV using 4th generation lab test. She tested on day 9 with the same tests.

I also did a full panel test on week 1 for the other STDs, which came back negative.

Would appreciate your views and recommendations please on the situation. 

Even though it was that long ago, I believe we discussed the low STI risk with most female escorts, especially "high end":  most are aware of the risks, take precautions to minimize them, tend to have clients at low risk (men like you), and get tested frequently. It's too bad the condom broke, but even entirely unprotected vaginal sex with such partners uncommonly results in HIV or any other STD.

The most important information you provide is your CSW partner's negative blood test 9 days after the exposure. That proves 100% she did not have transmissible HIV when you were with her:  with that information, you really didn't need testing yourself. But your negative AgAb (4th generation) blood test at 4 weeks also shows you were not infected. (These tests actually require 6 weeks for conclusive results, but the combination of her negative test result and yours amounts to 100% proof you do not have HIV.) 

Presumably your one week STD test panel included urine or urethral swab for gonorrhea and chlamydia, and those negative results are reliable. Your own blood tests were  meaningless at one week, but your escort partner's negative test results are reassuring. The only slight shadow at this point is syphilis:  there's a theoretical possibility she had infectious syphilis that was too early to show up on her blood test. However, syphilis is almost as rare as HIV in such persons and there is little chance you were exposed or infected. But for additional reassurance you might consider a syphilis blood test 6 weeks after the sexual exposure.

Bottom line:  For sure you do not have HIV, gonorrhea or chlamydia; and almost certainly nothing else either. If you have a regular partner, you can safely have unprotected sex with that person.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Yes, indeed it's been 5 years since my last question. However, I have been asking you questions since the MedHelp days (15+ years). It is always helpful to do that. In addition, I do refresh my knowledge every time I ask and browse the website. Glad you are around.

I think I will follow your advice and redo the Syphilis test on week 6. Other than that, I don't want to dig deeper into the rabbit hole. Thank you again for your services and guidance throughout the years.